Provider Demographics
NPI:1578509337
Name:RICKMEYER, MARK D (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:RICKMEYER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:714 GRAVOIS RD
Mailing Address - Street 2:STE 210
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7723
Mailing Address - Country:US
Mailing Address - Phone:636-660-9850
Mailing Address - Fax:636-660-9851
Practice Address - Street 1:714 GRAVOIS RD
Practice Address - Street 2:STE 210
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7723
Practice Address - Country:US
Practice Address - Phone:314-543-5230
Practice Address - Fax:314-543-5280
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-04-17
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Provider Licenses
StateLicense IDTaxonomies
MO106510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243764602Medicaid
G55023Medicare UPIN
G55023Medicare UPIN